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General NPI Number Information
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NPI Number | 1003614090
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Entity Type | Organization
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Legal Business Name | NEW EQUINOX INC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 229 N BLOCK AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5204
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Country | US
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Telephone | 479-310-0061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 324
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City | FAYETTEVILLE
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State | AR
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Zip | 72702-0324
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Country | US
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Telephone | 479-310-0061
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR/OWNER
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Name | CAMILLE BOSWELL
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Credential | LPC
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Telephone | 479-310-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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